Physiotherapists in Plymouth treat many different conditions including the issues profiled below.

Flat Feet

It is common for patients to present with progressive flat foot deformity, also known as pes planus. However, despite it being common there the causes and treatments are still under debate. Adult acquired flat foot is most likely to be caused by an imbalance between the active arch maintenance structures and the passive arch maintenance structures. The foot may have been normal at some stage and something has changed to bring on the process of flattening of the arches. The posterior tibial tendon plays a strong role in actively maintaining the inner arch and a dysfunction or weakness of this structure is thought to be important in flat foot.

However, the ligaments binding the medial arch together and maintaining its structure may also be deficient in some way, leading to flat foot problems. The spring ligament, a strong ligament running between the calcaneus (heel bone) and the navicular, supports the head of the ankle bone (talus) and stops its slipping downwards, thereby maintaining the arch of the foot. Deficiency of this ligament complex is thought to be equally important to problems with the posterior tibial tendon. Treatment typically starts with insoles and modified footwear and progresses to foot surgery.

Inflammatory Disease of the Entheses

Mechanical factors are thought to be important in inflammatory conditions of the ligament or tendon insertions so addressing these matters may be useful. Physiotherapists can assess the problem and prescribe corrective or cushioning insoles as needed. Local injections of corticosteroids can be useful to treat the pain of enthesitis in a single area. For more widespread inflammation the new biological agents (known as anti-TNF agents) have been shown to be of some use, particularly if the legs are affected as this is so disabling. Typically enthesitis is likely to settle with time so the prognosis is reasonable.

Physiotherapy treatment of this problem includes assessment of joint ranges for restrictions which are developing and the design of an individual exercise regime to maintain the ranges of motion of all the affected joints. Hydrotherapy is a very useful treatment medium for most of the arthritic diseases as it allows the performance of joint movements in a warm and supported environment, minimising the forces on the joints, until the patient is able to progress comfortably to exercises in air. Patient education is important with the physio stressing that the exercise programme, targeted at specific difficulties for each patient, and needs to be maintained daily over the long term.